OBJECTIVE:

Condyloma acuminata are anogenital warts caused by the human papillomavirus (HPV). HPV has become one of the most common sexually transmitted diseases in adults. Primary care physicians face the frustrating challenge of treating these lesions caused by anogenital HPV infections. Neglected giant peri-anal lesions require major surgical procedures. This report reflects our experiences and outcomes concerning the aggressive surgical approach toevam these rare presentation types of condyloma acuminata.

METHODS:

The medical records of four patients, diagnosed to have giant peri-anal genital warts, who were treated between April 1996 and September 2003 were reviewed and evaluated retrospectively. The operations were performed in two stages. In the first stage, full thickness tumor and skin excisions were performed followed by a delayed second stage, in which split thickness skin grafts were applied.

RESULTS:

Four patients (3 male, 1 female) who suffered of giant condyloma acuminata lesions obliterating the anal canal were evaluated. The median age was calculated to be 36.5 (24-52) years. The duration of their complaints ranged between 4 years to 18 years (median time 7 years). Two of these patients described themselves to have had a continued homosexual life style in their past history. All of our patients were detected to be HbsAg, Anti-HCV and Anti-HIV negative. All patients underwent wide surgical excisions. No anodermal invasions were to be observed. No diverting colostomies were needed to be performed, either. The wounds were left open for secondary healing of all patients and following a median time period of a 35 days delay, split thickness skin graftings were performed. The histopathologic examinations of the specimens of these four patients did not reveal any malignant transformations. No recurrences were detected at the end of a median follow-up period of 22 months.

CONCLUSION:

Peri-anal condyloma acuminata is usually a benign disease, but may grow locally at an excessive extent and may cause important peri-anal hygiene problems. Even though the incidence of malignant transformation is rare, there is always a risk for this complication to take place. Therefore, this disease must be treated aggressively with wide surgical excision. The results of the mentioned surgical t reatment methods are satisfactory.

Keywords: Giant condyloma acuminata, peri-anal, surgical treatment